The goal of this training program is to graduate physican-scientists to assume leadership roles in the field of academic Pediatric Nephrology. This is accomplished by an intense year of clinical training in all aspects of Pediatric Nephrology practice, supported by funds that are separate from this grant, followed by two-three years of comprehensive research training, either in basic science or clinical research. Trainees who complete the program are fully sub-board eligible in Pediatric Nephrology and expected to assume faculty positions at academic institutions and to begin the transition to independent investigative careers, usually via one of the mentored scientist programs. This program was developed in direct response to a critical manpower shortage in academic pediatric neprhology, which was/is coupled with the realization that most traditional pediatric nephrology training programs in this country are funded by clinical revenues and, therefore, provide inadequate research training in basic science and clinical investigation. It is estimaged that there is currently one pediatric nephrologist available in the U.S.A. for every 200,000 children. Comparatively, there are an estimated fourteen internist nephrologists per every 60,000 adults. Given recent significant advances in both molecular biology and clinical research, few traditional training programs in pediatric nephrology are presently designed to provide trainees with an opportunity to acquire substantive expertise with the methodologies and concepts of these disciplines. More than 6500 American children suffer from end-stage renal disease (ESRD), and many times that number are affected by chronic kidney disease. Currently, the entire ESRD program costs nearly $25 billion, with the federal government spending more than $17 billion. Despite these efforts, children receiving dialysis and transplantation have unacceptably high mortality rates, 3 times that of adults and more than 15% of the infant population. The reasons for this high mortality remain poorly defined, and, unfortunately, few studies are currently in progress to address this issue. Furthermore, it is now evident that many of the diseases that cause chronic kidney diseasse in adults begin in childhood. There is a pressing need to address these public health issues of kidney disease in children through research, and to train new physician-scientists to perform that critical work.